Fluticasone; vilanterol inhalation is not indicated for use in children. The safety and efficacy of the combination have not been established in infants, neonates, children, and adolescents. Available data from controlled clinical trials suggest that long-acting beta-agonists increase the risk of asthma-related hospitalization in pediatric and adolescent patients. Among subjects aged 12 to 17 years, asthma-related hospitalizations occurred in 4 subjects (%) treated with Breo Ellipta 100/25 (n = 151) compared with 0 subjects treated with fluticasone furoate 100 mcg (n = 130). There were no asthma-related deaths or asthma-related intubations observed in this trial. Growth inhibition has been observed in some children following therapy with high-dose fluticasone propionate inhalations (., Flovent). Children receiving fluticasone inhalations should be monitored closely for growth inhibition; the effect of fluticasone on final adult height is not known.
There is variation in the literature with regard to dosage regimens. Prednisone mg/kg/day to 1 mg/kg/day PO is commonly reported, followed by gradual taper over 3 to 6 weeks. Use of IV methylprednisolone for a few days may precede oral corticosteroid use. NOTE: Following biopsy to confirm diagnosis, corticosteroids are usually instituted soon afterward as an adjunctive measure; removal of the suspected offending agent /cause is the primary treatment. While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value.